TY - JOUR
T1 - Prognostic factors for survival differ according to CD4+ cell count among HIV-infected injection drug users
T2 - Pre-HAART and HAART eras
AU - Galai, Noya
AU - Vlahov, David
AU - Bareta, Joseph C.
AU - Wang, Cunlin
AU - Cohn, Sylvia
AU - Sterling, Timothy R.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2005/1/1
Y1 - 2005/1/1
N2 - To identify prognostic indicators of survival at different CD4+ cell levels, independent of highly active antiretroviral therapy (HAART), among injection drug users (IDUs). A community-recruited cohort of injection drug users followed semiannually from 1988 through 2000. Five partially overlapping subcohorts were defined by when participants first reached a CD4 cell level of 351 to 500, 201 to 350, 101 to 200, 51 to 100, or ≤50 cells/μL. Prognostic factors were measured at entry into each category. Kaplan-Meier survival estimates for HIV-related death and Cox regression models were constructed by CD4+ category. Among the 1030 HIV-infected IDUs, survival improved in the HAART-era with hazard ratios 0.42, 0.36, 0.24, 0.21, and 0.25, respectively, for CD4+ cell groups of 500 to 351, 350 to 201, 200 to 101, 100 to 51, and ≤50 cells/μL. Shorter survival was associated with prior hospitalization, AIDS, and sexually transmitted disease, with similar effects in the pre-HAART and HAART eras. For the lowest CD4+ cell level, prior sepsis or endocarditis, outpatient/emergency room visits, and alcohol use provide additional prognostic value. Survival among HIV-infected IDUs improved since the introduction of HAART, even though utilization of HAART was incomplete. Clinical and behavioral variables provided prognostic information about survival, including substance use indicators.
AB - To identify prognostic indicators of survival at different CD4+ cell levels, independent of highly active antiretroviral therapy (HAART), among injection drug users (IDUs). A community-recruited cohort of injection drug users followed semiannually from 1988 through 2000. Five partially overlapping subcohorts were defined by when participants first reached a CD4 cell level of 351 to 500, 201 to 350, 101 to 200, 51 to 100, or ≤50 cells/μL. Prognostic factors were measured at entry into each category. Kaplan-Meier survival estimates for HIV-related death and Cox regression models were constructed by CD4+ category. Among the 1030 HIV-infected IDUs, survival improved in the HAART-era with hazard ratios 0.42, 0.36, 0.24, 0.21, and 0.25, respectively, for CD4+ cell groups of 500 to 351, 350 to 201, 200 to 101, 100 to 51, and ≤50 cells/μL. Shorter survival was associated with prior hospitalization, AIDS, and sexually transmitted disease, with similar effects in the pre-HAART and HAART eras. For the lowest CD4+ cell level, prior sepsis or endocarditis, outpatient/emergency room visits, and alcohol use provide additional prognostic value. Survival among HIV-infected IDUs improved since the introduction of HAART, even though utilization of HAART was incomplete. Clinical and behavioral variables provided prognostic information about survival, including substance use indicators.
KW - AIDS
KW - Drug injection
KW - HIV
KW - Highly active antiretroviral therapy
KW - Mortality
KW - Substance abuse
UR - http://www.scopus.com/inward/record.url?scp=11844273783&partnerID=8YFLogxK
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U2 - 10.1097/00126334-200501010-00014
DO - 10.1097/00126334-200501010-00014
M3 - Article
C2 - 15608529
AN - SCOPUS:11844273783
SN - 1525-4135
VL - 38
SP - 74
EP - 81
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 1
ER -